EFFECTS OF DELAYED UMBILICAL CORD CLAMPING ON MATERNAL AND NEONATAL OUTCOMES IN IRRUA: A RANDOMIZED CONTROLLED (OPEN LABEL) TRIAL

Abstract

Background: Umbilical cord clamping and cutting is one of the most unique parts of the birth processes, but its optimal timing is yet to be clearly established. Evidence is fast growing favouring delayed umbilical cord clamping as it is beneficial with minimal or no risk to the mother and the baby. The importance of these benefits in our environment cannot be over emphasized as anaemia is a huge public health burden and most especially as the procedure is cost effective, practicable and

easy to perform in all settings.
Objective: This study was designed to assess the maternal and neonatal outcomes of delayed

versus early umbilical cord clamping in a Nigerian sub rural population.
Materials and methods: This was a prospective, three-armed, single centre randomized controlled (open label) trials in 1:1:1 ratio of mother and baby’s pairs. 234 participants were randomized into A, B and C arms, representing ECC within 30 seconds of birth, DCC at 2 minutes and three minutes for A, B and C respectively. Data was collected, computed and analyzed with the statistical package for social sciences (SPSS) version 20.0 IBM. Statistical comparison was done usingFisher’s exact test for three groups and Student’s t- test for two groups that are continuous variables while Chi-Square test was used for categorical variables. The level of significance was accepted when P-value is equal to or less than 0.05 and confident interval of 95 %.

Outcome measures: Primary outcomes were maternal blood loss post partum and neonatal packed cell volume, serum ferritin, transcutaneous bilirubin estimation/ serum bilirubin concentration at 48 hours after birth and the infant’s packed cell volume and serum ferritin at six weeks post delivery. Secondary outcomes were maternal postpartum haemorrhage and neonatal anemia, jaundice, SBCU admission, phototherapy and exchange blood transfusion. In addition placenta weight and umbilical cord length were compared across groups with maternal satisfaction.

Results: 234 mothers-babies pairs were randomized into three groups A, B and C with 6.8% drop out rate, hence 218 mothers-babies pairs were analyzed; 75 (34.4 %) for group A, 72 (33.0%) for group B and 71(32.6%) for group C.

The baby’s mean packed cell volume and serum ferritins were higher in the DCC than ECC at 48 hours (F=61.0, P= <0.001 and F= 150.0, P= <0.001 respectively) and were sustained at six weeks follow up after delivery (F=7.1, P= 0.001 and F= 379.1, P= <0.001 respectively). All the babies in group A (ECC) had anaemia which was less than 36 % in DCC groups. There was no significant difference between the three groups in respect to maternal blood loss, hyperbilirubinaemia, SCBU admission, and need for phototherapy. Delayed umbilical cord clamping for two minutes is better than ECC and is equally effective as DCC for three minutes.

The mean placenta weight was less in DCC than ECC (F=64.92, P= <0.001) but no significant difference was noted with the umbilical cord length. Follow up of cases with hyperbilirubinaemia showed a strong association to ABO incompatibility especially among group O Rh D positive mothers (X2=11.7, P=0.011). In overall maternal satisfaction was fair and was significant with respect to the study arms but not to parity, occupation, highest level of education and maternal age.

Conclusion: Delayed umbilical cord clamping is beneficial rather than harmful as it ensures higher packed cell volume and serum ferritin to the newborn even up to six weeks after birth at no maternal or neonatal risk. Two minutes of delay in umbilical cord clamping after birth is strongly recommended as an ideal optimal time for cord clamping in our rural setting. The risk of hyperbilirubinaemia in this study was due to ABO incompatibility rather than DCC.

 

EFFECTS OF DELAYED UMBILICAL CORD CLAMPING ON MATERNAL AND NEONATAL OUTCOMES IN IRRUA: A RANDOMIZED CONTROLLED (OPEN LABEL) TRIAL